ChamberlainNR 576 Midterm Exam Review Guide Actual
Exam 2026/2027 | Differential Diagnosis in
Adult-Gerontology Primary Care with Detailed Rationales
| Pass Guaranteed – A+ Gra University | 2026/2027
Academic Year
EXAM BLUEPRINT OVERVIEW
Table
Section Questio Cognitive Level
ns
Clinical Reasoning & Diagnostic Process 8 20% Recall / 50% Application / 30%
Analysis
Common Respiratory Presentations 12 Application/Analysis
Common Cardiovascular Presentations 12 Application/Analysis
Common Gastrointestinal Presentations 10 Application/Analysis
Common Musculoskeletal Presentations 10 Application/Analysis
, Common Neurologic Presentations 10 Application/Analysis
Common Endocrine & Metabolic 10 Application/Analysis
Presentations
Common Genitourinary Presentations 8 Application/Analysis
Common Dermatologic Presentations 8 Recall/Application
Geriatric Syndromes & Atypical 6 Analysis
Presentations
Integrative Case-Based Differential 6 Analysis
Diagnosis
TOTAL 100
SECTION 1: CLINICAL REASONING & DIAGNOSTIC PROCESS
(Questions 1–8)
Q1: A 72-year-old male presents with acute onset of severe, tearing chest pain that
radiates to his back. His blood pressure is 160/50 mmHg in the right arm and 130/70
mmHg in the left arm. Which diagnostic test should be ordered FIRST?
A. 12-lead ECG
B. Chest X-ray
,C. CT angiography of the chest [CORRECT]
D. Transthoracic echocardiogram
Correct Answer: C
Rationale: The presentation (tearing chest pain radiating to back with differential BP
between arms) is highly suspicious for aortic dissection; CT angiography is the definitive
first-line test due to rapid acquisition and high sensitivity/specificity.
Q2: A patient presents with symptoms of coronary artery disease. The pre-test
probability is estimated at 60%. A stress test with ECG is performed with a sensitivity of
68% and specificity of 77%. Using likelihood ratios, which statement best describes the
post-test probability if the test is positive?
A. Post-test probability decreases to approximately 30%
B. Post-test probability increases to approximately 80% [CORRECT]
C. Post-test probability remains unchanged at 60%
D. Post-test probability increases to approximately 95%
Correct Answer: B
Rationale: LR+ = sensitivity/(1-specificity) = 0.68/0.23 ≈ 2.96. Applying Bayes' theorem
with 60% pre-test probability and LR+ of ~3 yields post-test probability of approximately
80%. This demonstrates how diagnostic testing modifies probability assessment.
Q3: A 68-year-old female with diabetes and hypertension presents with fatigue. Her
provider immediately assumes this is due to her known diabetes without considering
other causes. This represents which cognitive error?
A. Availability heuristic
, B. Anchoring bias [CORRECT]
C. Confirmation bias
D. Premature closure
Correct Answer: B
Rationale: Anchoring bias occurs when a clinician relies too heavily on the first piece of
information encountered (her diabetes diagnosis) and fails to adjust adequately when
new information becomes available.
Q4: Which of the following test characteristics is MOST useful for ruling OUT a disease
when the test result is negative?
A. High sensitivity [CORRECT]
B. High specificity
C. High positive predictive value
D. High negative likelihood ratio
Correct Answer: A
Rationale: A highly sensitive test rarely misses true disease (few false negatives);
therefore, a negative result effectively rules out disease (SnNOut: Sensitive test,
Negative result, rules Out disease).
Q5: A 55-year-old male presents with chest pain. The pre-test probability of acute
coronary syndrome is 40%. A troponin I test has sensitivity 95% and specificity 89%.
What is the negative likelihood ratio (LR-)?
A. 0.056 [CORRECT]
B. 0.112
Exam 2026/2027 | Differential Diagnosis in
Adult-Gerontology Primary Care with Detailed Rationales
| Pass Guaranteed – A+ Gra University | 2026/2027
Academic Year
EXAM BLUEPRINT OVERVIEW
Table
Section Questio Cognitive Level
ns
Clinical Reasoning & Diagnostic Process 8 20% Recall / 50% Application / 30%
Analysis
Common Respiratory Presentations 12 Application/Analysis
Common Cardiovascular Presentations 12 Application/Analysis
Common Gastrointestinal Presentations 10 Application/Analysis
Common Musculoskeletal Presentations 10 Application/Analysis
, Common Neurologic Presentations 10 Application/Analysis
Common Endocrine & Metabolic 10 Application/Analysis
Presentations
Common Genitourinary Presentations 8 Application/Analysis
Common Dermatologic Presentations 8 Recall/Application
Geriatric Syndromes & Atypical 6 Analysis
Presentations
Integrative Case-Based Differential 6 Analysis
Diagnosis
TOTAL 100
SECTION 1: CLINICAL REASONING & DIAGNOSTIC PROCESS
(Questions 1–8)
Q1: A 72-year-old male presents with acute onset of severe, tearing chest pain that
radiates to his back. His blood pressure is 160/50 mmHg in the right arm and 130/70
mmHg in the left arm. Which diagnostic test should be ordered FIRST?
A. 12-lead ECG
B. Chest X-ray
,C. CT angiography of the chest [CORRECT]
D. Transthoracic echocardiogram
Correct Answer: C
Rationale: The presentation (tearing chest pain radiating to back with differential BP
between arms) is highly suspicious for aortic dissection; CT angiography is the definitive
first-line test due to rapid acquisition and high sensitivity/specificity.
Q2: A patient presents with symptoms of coronary artery disease. The pre-test
probability is estimated at 60%. A stress test with ECG is performed with a sensitivity of
68% and specificity of 77%. Using likelihood ratios, which statement best describes the
post-test probability if the test is positive?
A. Post-test probability decreases to approximately 30%
B. Post-test probability increases to approximately 80% [CORRECT]
C. Post-test probability remains unchanged at 60%
D. Post-test probability increases to approximately 95%
Correct Answer: B
Rationale: LR+ = sensitivity/(1-specificity) = 0.68/0.23 ≈ 2.96. Applying Bayes' theorem
with 60% pre-test probability and LR+ of ~3 yields post-test probability of approximately
80%. This demonstrates how diagnostic testing modifies probability assessment.
Q3: A 68-year-old female with diabetes and hypertension presents with fatigue. Her
provider immediately assumes this is due to her known diabetes without considering
other causes. This represents which cognitive error?
A. Availability heuristic
, B. Anchoring bias [CORRECT]
C. Confirmation bias
D. Premature closure
Correct Answer: B
Rationale: Anchoring bias occurs when a clinician relies too heavily on the first piece of
information encountered (her diabetes diagnosis) and fails to adjust adequately when
new information becomes available.
Q4: Which of the following test characteristics is MOST useful for ruling OUT a disease
when the test result is negative?
A. High sensitivity [CORRECT]
B. High specificity
C. High positive predictive value
D. High negative likelihood ratio
Correct Answer: A
Rationale: A highly sensitive test rarely misses true disease (few false negatives);
therefore, a negative result effectively rules out disease (SnNOut: Sensitive test,
Negative result, rules Out disease).
Q5: A 55-year-old male presents with chest pain. The pre-test probability of acute
coronary syndrome is 40%. A troponin I test has sensitivity 95% and specificity 89%.
What is the negative likelihood ratio (LR-)?
A. 0.056 [CORRECT]
B. 0.112
